Total Knee Anthroplasty: Patella Resurfacing Versus Nonresurfacing

Abstract

The results of total knee arthroplasty (TKA) with or without patellar resurfacing were restropectively evaluated in 164 knees of 128 patients. All of the patients recived primary total knee arthroplasty using a Miller-Galante I (MGI) prosthesis. Hybrid fixation including non-cemented femoral component with cemented tibial and patellar components was used in this series. The patella was resurfaced with cemented metal-backed patellar component when there was either gross destruction or eburnation of the articular surface. Hospital for Special Surgery (HSS) knee score, radiographic examination and muscle strength using isokinetic assessment were used to evaluate the functional status of knees. One hundred TKAs with patellar resurfacing and 64 TKAs without patellar resurfacing were evaluated. The average duration of follow-up was 4.8 years. The demographic data were similar between groups. The resurfacing group had worse preoperative HSS knee scores than the nonresurfacing group (p < 0.05). Yet, the final HSS knee scores were similar between two groups (p > 0.05). The resurfacing group had better muscle torque balance (Hamstring/Quadriceps ratio) than the nonresurfacing group (p < 0.05). There were more postoperative complications in the resurfacing group (21%) than the nonresurfacing group (4.7%). Seventeen patellar polyethylene wear in the resurfacing group caused chronic pain or click and required the revision surgery (17%). Although MGI TKAs with patellar resurfacing acquired similarly good knee's functional recovery as in those without resurfacing, yet, it had high patellar complications. Therefore, selective patellar resurfacing might be considered in primary TKA. The metal-backed patella components should be avoided and all-polyethylene designed component be used when patellar was resurfaced. Unlike most marketed knee system, all patients having a Miller-Galante 1 patella replacement were at future risk if they had not already failed.